588 PHILOSOPHICAL TRANSACTIONS. [aNNO I761. 



monstrous ^ize, while the rest of the heart remains nearly in its natural state. 

 It is but rare perhaps that the heart is seen so equally and universally enlarged, 

 as in the case under consideration. This man, Mr. P. observed, had the rickets 

 when a child: in this disorder the whole system was found to be in a very lax 

 debilitated state; and the heart \vas said to be so in particular. The constitutions 

 of rickety children frequently amend as they grow up, and particularly about the 

 age of puberty. But in this case Mr. P. thinks we may safely conclude, that 

 this man's heart never recovered its due tone after he grew up. It is scarcely to 

 be supposed that the heart could suffer so great an enlargement during the last 

 year or two of his life only: the more so, as he remembered to have heard him 

 say, that for many years before his death, a very little exercise put him out of 

 breath. Doubtless it was increased greatly during the latter years of his life, by 

 his business, which obliged him to exercise much, particularly in walking ; so 

 that before he got his rheumatism, he came home so weak, and so much fa- 

 tigued with his usual day's exercise, that he has been almost unable to stir for a 

 day or two. He adds to this the increased force that the heart sustained during 

 the time he laboured under his inflammatory disorders, both before and after his 

 rheumatism seized him. 



The great increase of his disorder, on going into the cold bath is not surpriz- 

 ing. The shock of the cold water, and the resistance necessarily given by that 

 means to the circulation, must occasion a vast surcharge of blood in the auricles 

 and ventricles of the heart, already too weak to perform its office with sufficient 

 power. Besides the impropriety of such a step, while there was reason to think 

 that the inflammatory spissitude of the blood was by no means overcome, the 

 preternatural distension was doubtless increased by this means. 



Hence however may be deduced a useful hint in practice; namely, where 

 from the state of the pulse, from a palpitation of the heart, a faint weak voice, 

 an aptitude to fall into lipothymies from slight causes, or from the concurrence 

 of any other symptoms, we have reason to suspect that the heart is too weak ; 

 in such cases, not to direct cold bathing, till the patient has been prepared for 

 it, by going into water between the degrees of tepid and quite cold water ; nay 

 probably it might be better to wait, before cold bathing be prescribed at all, til' 

 the effect of medicines seems previously to have invigorated in some degree the 

 cardiac system. 



The considering the heart as a muscle capable, like all others, of great alter- 

 ation respecting its tone ; and at the same time that such alteration must essen- 

 tially affect the whole animal economy, from the very great importance of the 

 organ itself, is evidently of great use in medicine. It must assist us in account- 

 ing for several phenomena that occur in various disorders, which are utterly in- 

 explicable by other means; and of consequence must lead to a more successful 



